Sleep Apnea: Service Connection & Ratings

What is Sleep Apnea?

Sleep apnea is a sleep disorder where breathing stops and starts repeatedly.  Obstructive Sleep Apnea (OSA) is the most common type of sleep apnea and occurs when the muscles in the back of the throat relax, which blocks airflow into the lungs.  Symptoms may include loud snoring, episodes when you stop breathing while asleep, gasping for air while asleep, waking up with a dry mouth, a headache in the morning, insomnia, excessive daytime sleepiness, difficulty focusing, and irritability.  Risk factors for OSA include excess weight; a thicker neck circumference; a narrowed airway; being male; being older; use of alcohol, sedatives or tranquilizers; and certain medical conditions.  Complications of OSA may include, but are not limited to, high blood pressure or heart problems, and diabetes mellitus type 2.

Sleep apnea is usually diagnosed by a sleep test, which may occur at a sleep center or at home.  Milder cases of sleep apnea may be treated with lifestyle changes.  Moderate to severe obstructive sleep apnea is commonly treated with a continuous positive airway pressure (CPAP) machine, although other treatments such as oral devices or other types of positive airway pressure machines are available.

Getting Sleep Apnea Service Connected

In order to be granted service connection for sleep apnea, you must show that it is directly related to service (direct service connection); it is caused or aggravated by an already service-connected disability (secondary service connection); or pre-existed service and was aggravated beyond its natural progression by service (service connection based on aggravation by service). There is currently no presumption associated with toxic exposure for service connection for sleep apnea.

Direct service connection requires you to show three elements:

1. a current disability / diagnosis (sleep apnea);

2. an event, injury, or disease in service; and

3. a link or nexus establishing that the current disability had its onset or inception in service.

Secondary service connection requires you to show:

1. a current disability / diagnosis (sleep apnea);

2. a service-connected disability; and

3. a link or nexus establishing that the current disability is proximately due to, or the result of, a service-connected condition, or that the increase in severity of a non-service-connected disability is attributable to aggravation by a service-connected disability, and not to the natural progression of the non-service-connected disability.

You may also show secondary service connection with obesity as an intermediate step. Although obesity itself may not be service connected, it can be used as a connector between a service connected disability and claimed disability. To show this, you must demonstrate:

1. the service-connected disability must have caused the Veteran to become obese;

2. the obesity as a result of the service-connected disability must have been a substantial factor in causing or aggravating the claimed disability (sleep apnea), and

3. the claimed disability (sleep apnea) would not have occurred but for the obesity caused or aggravated by the service-connected disability.

In order to show aggravation of a disability pre-existing service, you must show that the pre-existing disability (sleep apnea) was aggravated beyond its natural progression during service. VA will determine the pre-service “rating” and subtract this from the current determined rating in order to calculate the rating for compensation.

Rating Sleep Apnea

Once service connected, sleep apnea is rated under diagnostic code 6847, Sleep Apnea Syndromes (Obstructive, Central, Mixed) under the schedule of ratings for the respiratory system.  The rating criteria is:

• 100%: Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy.

• 50%: Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine.

• 30%: Persistent day-time hypersomnolence.

• 0%: Asymptomatic but with documented sleep disorder breathing.

Important to note here is that if you have been prescribed a CPAP for your sleep apnea, which is a common treatment for sleep apnea, you are entitled to a 50-percent rating!

Proposed Changes to the Rating Criteria

In 2022, VA published proposed changes to the rating criteria for sleep apnea with the intent of evaluating it based on resulting impairment rather than prescribed treatment.  This would change how VA would rate new claims for sleep apnea.  Importantly, if you are already service connected if/when these changes go into effect, your rating would not automatically change.  VA must rate you under whichever rating criteria is more advantageous to you, so if you would receive a higher rating under the old rating criteria, then it will continue to rate you under that rather than the new one.

The proposed new rating criteria is described here:

Specifically, VA proposes to assign a 0 percent evaluation when sleep apnea syndrome is asymptomatic, with or without treatment. VA would assign a 10 percent evaluation when treatment yields “incomplete relief.” VA would assign ratings above 10 percent (e.g., 50 and 100 percent) only when treatment is either ineffective or the veteran is unable to use the prescribed treatment due to comorbid conditions. VA would assign a 100 percent evaluation only if there is also end-organ damage. VA proposes to include an informational note that defines and gives examples of qualifying comorbid conditions, i.e., conditions that, in the opinion of a qualified medical provider, directly impede or prevent the use of, or implementation of, a recognized form of treatment intervention normally shown to be effective.

Please note, these have not been finalized and it is unknown if and when they may be finalized. 

If you believe your sleep apnea is due to your service or a service-connected disability, or are seeking assistance in pursuing a claim, please contact our office at 844-483-8737.